Chapter 24 + 23 COPD PrepU

A nurse on a postsurgical unit is aware of the high incidence of pulmonary embolism (PE) among hospitalized patients. What nursing action has the greatest potential to prevent PE among hospital patients?

Early ambulation and the use of compression stockings *For patients at risk for PE, the most effective approach for prevention is to prevent deep venous thrombosis (DVT).* Active leg exercises to avoid venous stasis, early ambulation, and use of elastic compression or intermittent pneumatic compression stockings are general preventive measures. Range of motion exercises, supplementary oxygen, incentive spirometry, and deep breathing exercises are not measures that directly reduce a patient's risk of DVT and consequent PE.

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances?

Respiratory acidosis *Increased carbon dioxide tension in arterial blood leads to respiratory acidosis and chronic respiratory failure.* In acute illness, worsening hypercapnia can lead to acute respiratory failure. The other acid-base imbalances would not correlate with COPD.

peak flow meter

(1) moving the indicator to the bottom of the numbered scale (2) standing up (3) taking a deep breath and filling the lungs completely (4) placing the mouthpiece in the mouth and closing the lips around it (5) blowing out hard and fast with a single blow 6) recording the number achieved on the indicator. If the client coughs or a mistake is made in the process, repeat the procedure. *Peak flow readings should be taken during an asthma attack.*

A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis?

Anxiety *In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxiety is a likely nursing diagnosis.* This client may have inadequate nutrition, making Imbalanced nutrition: More than body requirements an unlikely nursing diagnosis. Impaired swallowing may occur in a client with an acute respiratory disorder, such as upper airway obstruction, but not in one with a chronic respiratory disorder. Unilateral neglect may be an appropriate nursing diagnosis when neurologic illness or trauma causes a lack of awareness of a body part; however, this diagnosis doesn't occur in a chronic respiratory disorder.

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complication should the nurse monitor for?

Atelectasis In bronchiectasis, the retention of secretions and subsequent obstruction ultimately cause the *alveoli distal to the obstruction to collapse (atelectasis).*

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 85% for a patient with COPD. What stage should the nurse document the patient is in?

I

In which grade of COPD is the forced expiratory volume (FEV) less than 30%?

IV *Grade I (mild): FEV1 > 80% predicted Grade II (moderate): FEV1 50-80% predicted Grade III (severe): FEV1 <30-50% predicted Grade IV (very severe): FEV1 <30% predicted* *all are FEV1/FVC <70%; FEV1 forced expiratory volume in 1 sec; FVC forced vital capacity

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments?

Oxygen through nasal cannula at 2 L/minute When a client presents in the emergency department with an exacerbation of COPD, the nurse should *first administer oxygen therapy and perform a rapid assessment* of whether the exacerbation is potentially life threatening.

A commonly prescribed methylxanthine used as a bronchodilator is which of the following?

Theophylline Theophylline is an example of a methylxanthine. All the others are examples of inhaled short-acting beta2 agonists.

During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must:

continue to take antibiotics for the entire 10 days. The client demonstrates understanding of how to prevent relapse when he states that he must continue taking the antibiotics for the prescribed 10-day course. Although the client should keep the follow-up appointment with the physician and turn and reposition himself frequently, these interventions don't prevent relapse. The client should drink 51 to 101 oz (1,500 to 3,000 ml) per day of clear liquids.

A nurse has just completed teaching with a client who has been prescribed a meter-dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary?

"I do not need to rinse my mouth with this type of inhaler." *Mouth-washing and spitting are effective in reducing the amount of drug swallowed and absorbed systemically.* Actuation during a slow (30 L/min or 3 to 5 seconds) and deep inhalation should be followed by 10 seconds of holding the breath. The client should actuate only once. Simple tubes do not obviate the spacer/VHC per inhalation.

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction?

"Weigh yourself daily and report a gain of 2 lb in 1 day." *The nurse should instruct the client to weigh himself daily and report a gain of 2 lb in 1 day. COPD causes pulmonary hypertension, leading to right-sided heart failure or cor pulmonale.* The resultant venous congestion causes dependent edema. A weight gain may further stress the respiratory system and worsen the client's condition. The nurse should also instruct the client to eat a low-sodium diet to avoid fluid retention and engage in moderate exercise to avoid muscle atrophy.The client shouldn't smoke at all.

A 26-year-old woman is thankful to be alive after rear-ending a truck with her car. However, she experienced a sternal fracture from the force of her car's airbag and has been breathing shallowly to avoid exacerbating her pain. The nurse should consequently prioritize assessments related to:

Atelectasis To minimize the pain associated with a sternal fracture, the patient splints the chest by breathing in a shallow manner and avoids sighs, deep breaths, coughing, and movement. *This breathing pattern has the potential to cause diminished ventilation, atelectasis (collapse of unaerated alveoli), pneumonitis, and hypoxemia.*

Which interventions does a nurse implement for clients with empyema?

Encourage breathing exercises The nurse teaches the client with empyema to do breathing exercises as prescribed. *The nurse should institute droplet precautions and isolate suspected and clients with confirmed influenza in private rooms or place suspected and confirmed clients together.* The nurse does not allow visitors with symptoms of respiratory infection to visit the hospital to prevent outbreaks of influenza from occurring in health care settings.

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?

Take ordered medications as scheduled. Although avoiding contact with fur-bearing animals, changing filters on heating and air conditioning units frequently, and avoiding goose down pillows are all appropriate measures for clients with asthma, *taking ordered medications on time is the most important measure in preventing asthma attacks.*

You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia?

Encourage increased fluid intake. The nurse places the client in semi-Fowler's position to aid breathing and increase the amount of air taken with each breath. *Increased fluid intake is important to encourage because it helps to loosen secretions and replace fluids lost through fever and increased respiratory rate.* The nurse monitors fluid intake and output, skin turgor, vital signs, and serum electrolytes. He or she administers antipyretics as indicated and ordered. Antibiotics are not given for viral pneumonia. The client's activity level is ordered by the physician, not decided by the nurse

The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client's care plan?

Performing chest physiotherapy as ordered Nursing care includes helping clients manage pulmonary symptoms and prevent complications. *Specific measures include strategies that promote removal of pulmonary secretions, chest physiotherapy, and breathing exercises.* In addition, the nurse emphasizes the importance of an adequate fluid and dietary intake to promote removal of secretions and to ensure an adequate nutritional status. Clients with CF also experience increased salt content in sweat gland secretions; thus it is important to ensure the client consumes a diet that contains adequate amounts of sodium. As the disease progresses, the client will develop increasing hypoxemia. In this situation, preferences for end-of-life care should be discussed, documented, and honored; however, there is no indication that the client is terminally ill.

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment?

Providing sufficient oxygen to improve oxygenation *The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.*

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?

Respiratory acidosis *In status asthmaticus, increasing PaCO2 (to normal levels or levels indicating respiratory acidosis) is a danger sign signifying impending respiratory failure. * Understanding the sequence of the pathophysiologic processes in status asthmaticus is important for understanding assessment findings. Respiratory alkalosis occurs initially because the patient hyperventilates and PaCO2 decreases. As the condition continues, air becomes trapped in the narrowed airways and carbon dioxide is retained, leading to respiratory acidosis.